Five patients in the Kansas City leukemia surveillance program had a history of multiple myeloma prior to the onset of their acute leukemia. If one applies the Kansas City age/sex‐specific leukemia rates to an estimated population with multiple myeloma living in the study area during the 7‐year collection period, only 0.17 patients would be expected to develop acute leukemia. The five patients presented in this paper represent a significant increase in the observed over the expected incidence. Twenty‐six patients have now been reported who developed acute leukemia during treatment for multiple myeloma, and each had received an alkylating agent. These drugs may be direct leukemogens and the risk involved in their use must be recognized.

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During a 5-yr leukemia surveillance study in the metropolitan Kansas City area, four patients who had previously received irradiation therapy for carcinoma of the larynx developed acute leukemia. The frequency of occurrence represents a significant increase of the observed over the expected. These findings indicate that, even with such localized radiotherapy, the possibility of irradiation-induced leukemia must be considered in therapeutic decisions.